Safety and pharmacokinetic profile of apixaban in end-stage renal disease: A real-world analysis

eJHaem

article

Chen I. Tseng¹  Alistair J. Roddick¹  Matthew J. Bottomley¹  Susan Shapiro³  Udaya Udayaraj¹ 

[1] Oxford Kidney Unit, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust;Nuffield Department of Medicine, University of Oxford;Oxford Haemophilia and Thrombosis Centre, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust;Radcliffe Department of Medicine, University of Oxford;Oxford NIHR Biomedical Research Centre

关键词: anticoagulation;    apixaban;    atrial fibrillation;    dialysis;    end stage renal disease;    pharmacokinetics;   

DOI  :  10.1002/jha2.606

来源: Wiley

【 摘 要 】

Vitamin K antagonists (VKA) remain the primary treatment of nonvalvular atrial fibrillation (NVAF) in patients with end-stage renaldisease on dialysis for stroke prevention. However, the evidence ofbenefits for using VKA in dialysis patients remains inconclusive [1].VKAs pose problems in this cohort due to risk of calciphylaxis andlabile international normalised ration (INR), which may lead to adverseoutcomes [2, 3]. Sub-optimal anticoagulation control on VKA stronglycorrelates with increased risks of thromboembolic and bleeding events[4].Apixaban clearance is less dependent on renal function comparedto other direct-acting oral anticoagulants. Data from retrospectivestudies suggest that apixaban has at least similar efficacy in stroke prevention for NVAF, but lower bleeding risk compared to VKA in dialysiscohorts [5, 6]. Nevertheless, apixaban is currently only licensed for usein dialysis patients in the US but not in the UK or Europe.This was a single-centre prospective analysis carried out at OxfordKidney Unit to evaluate the efficacy and safety of apixaban when usedaccording to the local guideline at the dose of 2.5-mg twice daily (BD)for dialysis patients with NVAF (Supporting Information). As apixabanis not licensed for use in dialysis patients in the UK, the off-licenceuse was discussed with patients by supervising nephrologist prior totreatment initiation.

【 授权许可】

Unknown